increasing terrorist attacks

8/14/2019 Increasing Terrorist Attacks

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Terrorist Attack, WTC, USA,11th September 2001


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Serial Bomb Blast, Bengaluru25th July 2008


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Serial Bomb Blast, Ahmedabad27th July 2008


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Serial Bomb Blast, Delhi13th September 2008


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Serial Bomb Blast, Guwahati30th October 2008


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Terror Attack, Mumbai,26th November 2008


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Serial Bomb Blast, Guwahati1st January 2009


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Introduction

9/11/2001- Terrorist attack on WTC at

USA Serial Blasts at Bengaluru,

Ahmedabad, Gwahati, Delhi withinlast six months

26/11/2008- Recent terrorist attackat Mumbai

All these lead to hundreds of deaths,

thousands of causalties, huge loss


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Introduction

All these incidence are increasingday by day.

Recent attacks also targetedhospitals, meant for treatment of

injured victims !!


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What happens in suchincidence?

Wounding of hundreds of people: Needingimmediate medical attention>Overcrowding of the near by hospitalswith limited resources.

Non availability of some life saving drugslike Anti gas gangrene vaccine,antibiotics, anti tetanus serum etc. inhuge quantity further aggravate the

situations.Deaths of large number of people: All

deaths being medico-legal, needingpostmortem examinations to fulfill

various objectives including difficult task


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Medical management of suchsituation

Before the incidence:

Preplanning and prior preparedness areessential requisite to tackle suchincidence.

All the live saving drugs including

antibiotics, pain killers, vaccines shouldbe readily available in sufficientquantities within short notice.

Proper training of medical andparamedical staffs to handle such


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During the incidence:

Proper co-ordination is required among

govt. agencies, law enforcementagencies, NGOs, electronic media and

local volunteers. Cordoning of the site by the police.

Extinguishing of fire, removal of injured ordead from the debris by fire brigades.

Time is the key for survival of the injuredvictims.


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It is not possible to give emergency

treatment at the site of incidence.

As far as possible, triage should be

started at the site of incidence. Oneteam of doctors should rush to theincidence site. They should haveproper knowledge of the capacities ,

available facilities, medical manpowerof the different hospitals situated in


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Depending upon the available timeperiods, injured should be distributed

and prioritized then and there andtransported accordingly for proper

management. Large number of well equipped

ambulances with teams of doctors andsupporting staffs are required for

initiation of treatment /early


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Treatment of injured: Saving the life of patient is most vital

All the departments dealing with trauma

management should be available at oneplace.

Consent and other medico-legal formalitiesmay be ignored at that valuable time

period. Patient with minor injuries should be

discharged shortly after giving necessarytreatment to avoid overcrowding.

During treatment, prevention/minimization


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After the incidence (treatment):

Physiotherapy as required.

Rehabilitation of the survivors.

Psychological counseling to the survivors

and survivors of the victim.


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Role of Forensic Pathologist in suchSituation

Fixing of identity is a great challenge forForensic Expert, and in almost all casesautopsy is to be performed as unknown,unclaimed or mutilated dead bodies.

Post mortem examination of all thecasualties is must to confirm the cause ofdeath.

Fixing Identity and confirmation of event byPreservation and collection of evidencesfor Forensic Examination (DNA Evidence,Blood Grouping etc.).

Almost all wounded patients need CasualtyServices. Forensic experts are the best to

access internal injuries from externalexamination, when time does not permit


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For Post Mortem Examination, Demarcationof additional staff & space and rapiddisposal of cases is the need of hour incases of Mass Casualties.

For creating Temporary Mortuary, use oftents, folding tables & adequate quantityof equipments may be needed.

Mobile vans may be used for On the Site

Post Mortem Examination. Facility of Cold Storage Cabinets or

arrangement of Ice Cubes (blocks) forkeeping the dead bodies till waiting for

relatives or final disposition of dead


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Provision for adequate water supply,arrangement of lights must be ensuredbefore performing On the Site Post

Mortem Examination. Another important point needs emphasis

here is to ask for adequate securityarrangements to avoid Secondary

Disaster due to Law and Order


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.And in Future

Till date, all these attacks were limited to

either explosion or firing.

In the coming days, terrorist attacks usingbiological weapon, chemical weapon and

nuclear weapon (Dirty Bomb) cannotbe denied.

In the above scenario, are the medical

profession ready to fulfill the needs ofvictims and survivors of the victims?


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In case of Bioterrorism:

Bioterrorism is the deliberate release ofharm full pathogens into a community.

The most likely agents to be used areanthrax, small pox, botulism, plague,

and tularemia. Lassa and Ebola viruses can be additional

agents.

Terrorist can attack at both urban and rurallocalities.


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What will happen inBioterrorism?

Diagnosis will be delayed for several daysbecause:

No one will suspect about bioterrorism.

Patients will come to primary doctorsinstead of emergency room.

Non specific signs and symptoms likecoughing, vomiting, fever and rashes of

the diseases will be confused with othercommon disorders.

Primary doctors will hesitate to consult aninfectious disease s ecialist.


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Extensive and expensive investigationsmay not be advised to reduce burden on

their patient. Modern laboratory investigation facilities

may not be there in rural areas.

Current system of communication among

hospitals, physician and public healthauthorities is very poor. Even, doctorshave not high speed communicationsystems needed to broadcast or receive

the reports.


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..And till diagnosis is made orbioterrorism is suspected;

There can be huge morbidity and mortalityin the community.

There can be spread of wave of panic inthe entire community, nation.

Even medical and paramedical staffs willbe contaminated by the disease due to

ignorance.


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Management forBioterrorism

Whenever there is doubt, doctors should

not hesitate to consult fellow colleagueand infectious disease specialist.

Any suspicion about such diseases shouldbe thoroughly investigated.

Diagnosis should be made at the earliest. Once, diagnosis is made, it should be

communicated to the concerned publicauthority immediately.


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Management forBioterrorism

Doctors, paramedical and diagnostic

laboratory staffs should take preventivemeasures to avoid contamination.

Most of these disease are treatable byadministering antibiotic or toxin

antagonist except small pox and otherviral infections where quarantine is thekey.

Public awareness should be made throughmedia to calm the panic community.


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In case of Chemicalterrorism

Several chemicals might be used in aterrorist attack including nerve gases(such as Sarin), cyanide, phosgene andmustard gases.

Unlike a bioterror attack, a chemical attackis immediately apparent.

Individuals present dramatic signs and

symptoms including extreme shortness


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What will happen in Chemical

Terrorism?

Doctors and paramedical staffs will be firstto see the victims.

Casualty will be overcrowded with thepatients.

Reducing morbidity and mortality willdepend essentially upon rapidity oftreatment.

As time is of essence of treating achemical attack, there is no time fortriage, and nearest hospital is best for


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Management for ChemicalTerrorism

As time is most essence for treatment,every local hospital must be prepared toreceive large number of casualties.Practically, there will be no time to sendthe victims to larger hospitals orhospitals with experienced staffs.

Management of a chemical attack requires

both pharmacological support and


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Management for ChemicalTerrorism

Dirty side and clean side must bemaintained at the scene of incidence,ambulance and hospital includingtreatment apparatus. Proper planning

must be done in this regard. Administration of proper antidote and life

support in time.

Doctors should use preventive measures

avoid self contamination.


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In case of Nuclear (Dirty Bomb)Terrorism :

A dirty bomb is a radiological weaponconsisting of a conventional explosivepackaged with radioactive material thatscatters when the bomb explodes.


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What will happen in NuclearTerrorism?

The conventional explosive will causemost of the injuries and death from adirty bomb

The radiation can also cause severe illnessand death, and, in the long run, a

slightly increased cancer risk.

Doctors of community hospital may notbother much about the consequence of

M t f N l


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Management for NuclearTerrorism

Proper planning is essential. Beside treating the injured, community

hospitals need to be well equipped anddifferent staffing pattern to handleradiation bomb attack.

All the suspected patients needdecontamination in an orderly fashion,radiological monitoring anddecorporation ( removal of radioactivematerials that have been incorporatedinto the body).

Doctors and health professional need to


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Present shortcomings to deal terroristattack

Govt. gradually withdrawing from itsresponsibility to provide proper health

care for all. Health budget is going lessand less.

With increasing population, there is nosuch rise in public heath facilities.

Private hospitals never showresponsibilities towards the community.

There are several reports that dead body

was not handed over to the poor


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When poor people are striving to earn foodfor family, never expect them to buy anhealth policy by paying heptic premium.

Most of the public health centers lack evenbasic facilities including equipments andproper staffs.

Security arrangements at hospitalpremises is very poor. When beatingduty doctors and vandalizing hospitalpremises by common public are socommon occurrences, think, what

terrorist cannot do inside the hospital,


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Till date, there is no proper plan tomanage such man made disasters.

There is no synchronization among peopleresponsible for dealing such situations.

Doctors and paramedical staffs are notproperly trained to deal such situations.

There is lack of counseling centers forvictims and survivors of the victims. Orphans of the victims are not taken care,

even those of dead soldiers.


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Recommendations

Govt. must take its responsibility toprovide health for all.

More number of public health centersshould be opened to cater huge poor

Indians. All the public health centers should beprovided with modern facilities andproperly staffed.

Trauma centers should be opened at every


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Recommendations

Health professionals should be properlytrained to deal victims of terror attacks,

either by introducing it in UG curriculumor by providing special training.

All the public hospitals should be providedadequate security.

Establishment of Psychological counselingcenters.

Establishment of more number of FingerPrint Bureau/ DNA laboratories for proper

identification of dead individuals, with


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Recommendations

Proper rehabilitation of the terror victims.

Proper care of orphans of the terrorvictims.

Private hospitals may be encouraged totake social responsibilities. Wheneverpossible, govt. should provide themnecessary aid.

S l ti O J D d d


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Saluting Our Jawans, Dead andAlive


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T H A N K YT H A N K Y

O UO U

increasing terrorist attacks

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